This article was downloaded by: [Mohammad Mullick] On: 27 August 2012, At: 10:23 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Mental Health, Religion & Culture Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/cmhr20 Beliefs about Jinn, black magic and evil eye in Bangladesh: the effects of gender and level of education Mohammad S.I. Mullick a , Najat Khalifa b , Jhunu S. Nahar a & Dawn-Marie Walker c a Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University(BSMMU), Shahbagh, Dhaka, 1000 Bangladesh b Nottinghamshire Healthcare NHS Trust, Wells Road Centre, Nottingham, NG3 3AA, UK c The Research Design Service for the East Midlands, University of Nottingham, 14th. Floor, Tower Building, Nottingham, NG7 2RD, UK Version of record first published: 24 Aug 2012
To cite this article: Mohammad S.I. Mullick, Najat Khalifa, Jhunu S. Nahar & Dawn-Marie Walker (2012): Beliefs about Jinn, black magic and evil eye in Bangladesh: the effects of gender and level of education, Mental Health, Religion & Culture, DOI:10.1080/13674676.2012.717918 To link to this article: http://dx.doi.org/10.1080/13674676.2012.717918
PLEASE SCROLL DOWN FOR ARTICLE
Full terms and conditions of use: http://www.tandfonline.com/page/terms-and- conditions This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material. Downloaded by [Mohammad Mullick] at 10:23 27 August 2012 Mental Health, Religion & Culture 2012, 1–11, iFirst
Beliefs about Jinn, black magic and evil eye in Bangladesh: the effects of gender and level of education Mohammad S.I. Mullicka*, Najat Khalifab, Jhunu S. Nahara and Dawn-Marie Walkerc
aDepartment of Psychiatry, Bangabandhu Sheikh Mujib Medical University(BSMMU), Shahbagh, Dhaka, 1000 Bangladesh; bNottinghamshire Healthcare NHS Trust, Wells Road Centre, Nottingham, NG3 3AA, UK; cThe Research Design Service for the East Midlands, University of Nottingham, 14th. Floor, Tower Building, Nottingham, NG7 2RD, UK (Received 28 July 2012; final version received 31 July 2012)
The study was aimed to examine beliefs among 320 attendees of a large University Hospital in Dhaka about Jinn, black magic and evil eye among Muslims in Bangladesh, using a self-completed questionnaire. The majority believed in the existence of Jinn (72%) and in Jinn possession (61%). In contrast, a relatively smaller proportion believed in the existence of black magic and evil eye (50% and 44%, respectively). Women were more likely than men to believe in the existence of Jinn and to cite religious figures as the treating authority for diseases attributed to affliction by black magic. Participants with a higher educational attainment were less likely than those with lower attainment to believe in jinn possession; or to believe that Jinn, black magic, or evil eye could cause mental health problems. Mental health care practitioners need to be mindful of these beliefs to achieve the best outcome for their patients. Keywords: Jinn; black magic; evil eye; transcultural psychiatry; culture and mental health; Bangladesh
Introduction Muslims believe in the existence of three separate, but parallel, worlds: Mankind, Angels (messengers of God) and Jinn. According to the Islamic belief, Jinn are creatures who
Downloaded by [Mohammad Mullick] at 10:23 27 August 2012 conceal themselves from Mankind, so they see us but they cannot be seen. Jinn have the same needs as Mankind; they eat, drink, procreate, reproduce and die (Al-Ashqar, 2003). The widely accepted belief amongst Muslims is that Jinn are capable of causing physical and mental harm through possession (Khalifa & Hardie, 2005), which is when an individual has been entered by an alien spirit which then controls the person (Dein, 1997; Littlewood, 2004). Some Muslims also believe in black magic and evil eye (Khalifa, Hardie, Latif, Jamil, & Walker, 2011). There are numerous references to black magic and evil eye in the Islamic literature. Black magic refers to the claimed ability to alter things by supranatural means with the intention of causing harm or destruction. Evil eye refers to the ability mankind has to
*Corresponding author. Email: [email protected]
ISSN 1367–4676 print/ISSN 1469–9737 online ß 2012 Taylor & Francis http://dx.doi.org/10.1080/13674676.2012.717918 http://www.tandfonline.com 2 M.S.I. Mullick et al.
inflict harm on others either mentally or physically by giving them an envious glance (Dein, Alexander, & Napier, 2008). However, the extent to which beliefs about Jinn, black magic and evil eye can affect health behaviour among Muslims remains contentious (Dein et al., 2008). In the Arabic World, where the majority are Muslims, the belief that Jinn can enter the human body and cause mental illness is widely accepted, with symptoms such as forgetfulness, lack of energy and morbid fears being commonly attributed to Jinn and evil eye (El-Islam, 1995). However, patients displaying psychiatric symptomatology who believe they are possessed by Jinn, usually have underlying physical or mental health problems (Bayer & Shunaigat, 2002). These authors also found that the majority of their participants were young, uneducated, unemployed, males. The correlation between education and belief in Jinn has been supported by other studies such as Dein et al. (2008). It is also seen that ‘‘higher caste’’ people showed greater belief in natural causes of mental illness than spiritual reasons (Kakar, 1988), which could be arguably linked, amongst other factors, to education. Further, a study of beliefs about psychosis and marital instability among Nigerian immigrants in USA, Olusesi (2008) found that participants with highest level of education (post graduate level) were less likely to believe in supranatural causations for psychosis and marital instability than those with lower levels of education. Looking at the broader international Muslim perspective, Khalifa et al. (2011) examined beliefs about Jinn, black magic and evil eye of Muslims in the United Kingdom. They found that almost half of the participants believed in the existence of the Jinn, black magic and evil eye, with significantly more women believing in evil eye and black magic than men. Although fewer participants believed in possession, the majority of the sample believed that Jinn and black magic could cause mental illness, whilst they attributed physical illness to evil eye. This finding in a Muslim UK population has been supported by other studies. For instance, Dein et al. (2008) in their study of notions of misfortune among Bangladeshi community in East London found that belief in Jinn possession was not uncommon at times of psychological distress especially when coping with unexplained physical symptoms. Regarding mental health, psychological difficulties such as anxiety or depression, are often regarded as indicative of an unsound spiritual heart by some Muslims (Weatherhead & Daiches, 2010) and that mental illness can be due to either a defective relationship with God, as punishment from Him (Al-Krenawi & Graham, 1999) or due to a lack of faith or praying (Weatherhead & Daiches, 2010). Psychosis, however, is regarded as an organic Downloaded by [Mohammad Mullick] at 10:23 27 August 2012 disorder and more serious than mood disorders, therefore less controllable by the person, which may lead to more acceptance in accessing mental health care (Weatherhead & Daiches, 2010). This can lead to conflict between orthodox medicine and religiosity as surmised in a paper by Cinnirella and Loewenthal (2001): depression may be denied as believed to be impossible in a truly religious person; patients may use a range of religion- based coping strategies without telling their doctor; and there maybe distrust amongst religious sources regarding psychotherapists/psychiatrists. These factors lead to low referral rates of Muslims to mental health care (Aloud, 2004), particularly in the UK Pakistani population (Cochrane, 1983). However this may also be due to the effectiveness of support amongst the Muslim community (Cinnirella & Loewenthal, 1999). Muslims appear to be underrepresented in voluntary accessed services, such as counselling or outpatient care (Weatherhead & Daiches, 2010) with formal services only being accessed at critical times. Perceptions of honour appear to play a role in this decision process, and seeking help is a sign of weakness by other members of the community, which in turn Mental Health, Religion & Culture 3
affects one’s reputation (Weatherhead & Daiches, 2010). This lack of self-referral or asking for help at an early stage, leads to a poorer prognosis, which in turn, results in over representation of black and ethnic minority groups in non-voluntary services such as in- patient care under section (Weatherhead & Daiches, 2010) due to crisis being reached before help is sought. Muslims may believe that religious interventions such as reciting the Qur’an can cure emotionally disturbed people (Abu-Ras & Abu-Bader, 2008), therefore may deter them from accessing primary care. This is a particular problem for Muslim women who are more likely to seek help from relatives or religious leaders (Abu-Ras & Abu-Bader, 2008) mainly due to lack of financial freedom, or familiarity with services (Abu-Ras, 2003, 2007). While religiosity can help prevent mental illness, as religious Muslims self-report better mental health than non-religious Muslims (Abdel-Khalek, 2007, 2008), this could reflect reluctance to report that they had poor mental health due to stigma of poor religiosity. The present study aims to further expand the knowledge regarding beliefs about Jinn or other supernatural entities among Muslims in Bangladesh and whether they believe that these could cause mental health problems and who they think are best to treat them; doctors, religious figures or both (working together) and the effects of gender and level of education on these beliefs. Based upon previous literature it is hypothesised that there will be a correlation between belief in Jinn, evil eye and black magic with a low education and being female. Bangladesh lays in the north-eastern part of South Asia, with a geographical area of 1, 47,570 sq km and a population estimate of 156 million. Bangladesh is largely homogeneous in regards to ethnicity (Asiatic Society of Bangladesh, 2010), with most of its population being working age, that is, 61% aged between 15 and 64 years. Of these the gender ratio is 0.9/1.0 male/female. Literacy rates are 53% and 45% for men and women respectively. Islam is the most commonly practiced religion with 90% of the population describing their religion as Muslim (Bangladesh Bureau of Statistics, 2004).
Method Setting The current study was conducted in Dhaka, the capital of Bangladesh. The population of Dhaka is 10,712,206; with 56% males and 43% females. The average literacy rate in Dhaka is about 65% which is higher than the general population of Bangladesh. The
Downloaded by [Mohammad Mullick] at 10:23 27 August 2012 literacy rate in Dhaka is higher amongst males than females; 70% and 60%, respectively (Bangladesh Bureau of Statistics, 2004).
Participants Muslims aged 18 and over who were accompanying patients to various medical outpatient departments of the Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital, Dhaka, a tertiary university hospital which accepts referrals from all parts of Bangladesh.
Procedure Ethical approval to conduct the study was obtained from the relevant authority at BSMMU in Dhaka. Participants were approached at random by using the outpatient attendees register as the sampling frame. Data were collected by a postgraduate trainee 4 M.S.I. Mullick et al.
attached to the Department of Psychiatry with a background in psychology and sociology, after they were adequately trained in data collection by the first author. After explaining the study and obtaining informed consent, participants were invited to complete the questionnaire which was self-administered. However, for those who self-reported as having an inability to read or write, (n ¼ 12), the questions were read out to them and their answers were recorded by the postgraduate trainee.
The questionnaire The questionnaire was adapted from a previous study conducted in the UK (Khalifa et al., 2011). The original questionnaire had four sections (a copy can be obtained from the authors). The first section collected demographic information including gender, age, marital status and employment status. The second section was regarding beliefs about Jinn, black magic and evil eye. Participants were asked whether these existed in reality, and whether they could cause mental health difficulties. The third section assessed views on whether medical doctors, religious figures, that is, Alem, Hakim, Mullah, or Imam, or both working together should treat health problems. In relation to the treating authority, participants could endorse as many options as they felt were appropriate. Finally, space was provided at the end of the survey where respondents could write anything they wished to add. The original questionnaire was modified by adding items regarding the levels of education, income and the provision of open ended questions for participants to elaborate if they so wished. Level of income was categorised into three bands based upon the classification used by the Bangladesh Bureau of Statistics (2009): Low income, that is, less than 10,000 Taka (US$ 100) per month; Middle income, that is, 10,000–20,000 Taka (US$ 140–280) per month; and high income, that is, over Taka 20,000 (US$ 280) per month. The level of education was categorised into three groups based on the last school attended; primary or below, secondary, or higher. The questionnaire was translated into Bangla by the first author (MM). Great care was taken to ensure that the translation was culturally sensitive, for example, using only those words and idioms that would readily be understood by all Bangla-speakers, irrespective of their social or educational backgrounds. In this study, all open-ended comments were translated from Bangla into English by the first author (MM). Downloaded by [Mohammad Mullick] at 10:23 27 August 2012 Analyses The data were analysed using descriptive statistics and comparison of beliefs by gender and level of education was conducted using non-parametric statistics. Multinomial logistic regression was used to examine effects of gender and level of education (predictor variables) on belief systems (outcomes variables) which were entered individually into the regression equation.
Results A total of 326 individuals were approached, of whom five refused to participate, giving a response rate of more than 98%. Data cleaning was performed by ranking data according to their variables to look for any obvious keystroke errors, also to detect any missing data. Where any query arose, the original document would be cross referenced with the data set. Mental Health, Religion & Culture 5
Table 1. Sample characteristics.
Male Female Total (n ¼ 195) (n ¼ 125) (n ¼ 320)
Age group 18–30 97 63 160 31–40 53 35 88 41–50 24 19 43 51–60 19 7 26 460 2 1 3 Marital status Married 108 82 190 Single 86 32 118 Divorced/separated/widowed 1 11 12 Employment status Employed 143 24 167 Unemployed 6 5 11 Student 36 27 63 Home maker 0 64 64 Retired 10 5 15 Level of education Primary or below 37 52 89 Secondary 63 42 105 Higher 95 31 126 Level of income Lower 32 30 62 Middle 159 89 248 Higher 4 6 10
As a result of data cleaning, one participant was excluded because of incomplete data. Therefore, the final sample comprises of 320 participants on whom a full set of data were available for analysis. Sample characteristics are summarised in Table 1. In brief, the majority were aged between 18 and 30 (50%), married (60%), and employed (52%). Regarding income and Downloaded by [Mohammad Mullick] at 10:23 27 August 2012 education, more than 75% of participants were of middle income and about 40% of them had completed higher education. As can be seen in Table 2, the majority believed in the existence of Jinn (72%) and in Jinn possession (61%). In contrast to this, a relatively smaller proportion believed in the existence of black magic and evil eye (50% and 44%, respectively). Females were more likely than males to believe in Jinn (p ¼ 0.046), Jinn possession (p ¼ 0.003) and evil eye (p 5 0.001). Also, females were more likely than males to cite religious figures as the treating authority for diseases attributed to affliction by black magic (p ¼ 0.037) and evil eye (p ¼ 0.001). Regarding level of income, only a small proportion of participants fell in the higher income category (n ¼ 10), therefore it was not possible to draw valid conclusions from analyses using level of income as a covariate. However, analyses regarding the effect of education (Table 3) showed that participants with a higher educational attainment were less likely than the other two groups (primary or below, or secondary education) to believe Downloaded by [Mohammad Mullick] at 10:23 27 August 2012 6
Table 2. Beliefs about Jinn, Black Magic and Evil Eye: comparison by gender.
Male (total ¼ 195) n (%) Female (total ¼ 125) n (%) Statistics Yes No DK Yes No DK
Belief in Jinn 133 (68) 59 (30) 3 (2) 99 (79) 23 (18) 3 (3) LR ¼ 5.92, p ¼ 0.046* Jinn possession 105 (54) 79 (40) 11 (6) 91 (73) 29 (23) 5 (4) X2 ¼ 11.64, p ¼ 0.003* Jinn causing MHD 74 (38) 98 (50) 23 (12) 68 (54) 45 (36) 12 (10) X2 ¼ 8.44, p ¼ 0.015* 2 RF treating Jinn affliction 102 (52) 75 (38) 18 (10) 76 (61) 36 (29) 13 (10) X ¼ 3.14, p ¼ 0.208 Mullick M.S.I. Doctors treating Jinn affliction 68 (35) 96 (49) 31 (16) 37 (30) 74 (59) 14 (11) X2 ¼ 3.26, p ¼ 0.195 Doctors & RF treating Jinn affliction 63 (32) 98 (50) 34 (18) 43 (34) 55 (40) 27 (22) X2 ¼ 1.41, p ¼ 0.492 Belief in black magic 92 (47) 97 (50) 6 (3) 69 (55) 53 (42) 3 (3) X2 ¼ 1.97, p ¼ 0.373 BM causing MHD 72 (37) 99 (51) 24 (12) 59 (47) 50 (40) 16 (13) X2 ¼ 3.87, p ¼ 0.114 RF treating BM affliction 71 (36) 98 (50) 26 (14) 63 (50) 46 (37) 42 (13) X2 ¼ 6.64, p ¼ 0.037* doctors treating BM affliction 60 (31) 109 (56) 26 (13) 38 (30) 71 (57) 16 (13) X2 ¼ 0.031, p ¼ 0.985 Doc & RF treating BM affliction 48 (25) 115 (59) 32 (16) 33 (26) 69 (55) 23 (19) X2 ¼ 0.46, p ¼ 0.795 al. et Belief in EE 69 (35) 119 (61) 7 (4) 72 (58) 48 (38) 5 (4) X2 ¼ 16.03, p 5 0.001* EE causing MHD 40 (20) 126 (65) 29 (15) 29 (23) 71 (57) 25 (20) X2 ¼ 2.19, p ¼ 0.33 RR treating EE affliction 61 (31) 103 (53) 31 (16) 64 (51) 43 (34) 18 (15) X2 ¼ 13.51, p ¼ 0.001 Doctors treating EE affliction 64 (33) 104 (53) 27 (14) 40 (32) 68 (54) 17 (14) X2 ¼ 0.035, p ¼ 0.983 Doc & RF treating BM affliction 48 (25) 113 (58) 34 (17) 34 (27) 64 (51) 27 (22) X2 ¼ 1.51, p ¼ 0.486
Notes: *Significant at 0.05 LR ¼ Likelihood ratio; RF ¼ religious figures; MHD ¼ mental health difficulties; BM ¼ black magic; EE ¼ evil eye. Downloaded by [Mohammad Mullick] at 10:23 27 August 2012
Table 3. Beliefs about Jinn, black magic and evil eye: comparison by level of education.
Level of education
Primary or below Secondary Higher (total ¼ 89) n (%) (total ¼ 105) n (%) (total ¼ 126)n (%) etlHat,Rlgo Culture & Religion Health, Mental Yes No DK Yes No DK Yes No DK Statistics
Belief in Jinn 65 (73) 22 (25) 2 (2) 84 (80) 19 (18) 2 (2) 83 (66) 41 (32) 2 (2) LR ¼ 6.48, p ¼ 0.166 Jinn possession 67 (75) 21 (24) 1 (1) 74 (70) 29 (28) 2 (2) 55 (44) 58 (46) 13 (10) X2 ¼ 32.02, p 5 0.001* Jinn causing MHD 48 (54) 25 (28) 16 (18) 56 (53) 44 (42) 5 (5) 38 (30) 74 (59) 14 (11) X2 ¼ 38.29, p 5 0.001* RF treating Jinn affliction 62 (70) 17 (19) 10 (11) 64 (61) 36 (34) 5 (5) 52 (41) 58 (46) 16 (13) X2 ¼ 32.29, p 5 0.001* Doctors treating Jinn affliction 23 (26) 51 (57) 15 (17) 41 (39) 54 (51) 10 (10) 41 (33) 65 (52) 20 (16) X2 ¼ 5.29, p ¼ 0.258 Doc & RF treating Jinn affliction 32 (36) 40 (45) 17 (19) 34 (32) 55 (53) 16 (15) 40 (32) 58 (46) 28 (22) X2 ¼ 2.46, p ¼ 0.651 Belief in BM 52 (59) 35 (39) 2 (2) 58 (55) 46 (44) 1 (1) 51 (40) 69 (55) 6 (5) X2 ¼ 10.15, p ¼ 0.035* BM causing MHD 48 (54) 23 (26) 18 (20) 47 (45) 50 (47) 8 (8) 36 (29) 76 (60) 14 (11) X2 ¼ 15.01, p ¼ 0.001* RF treating BM affliction 54 (61) 21 (23) 14 (16) 46 (44) 50 (47) 9 (9) 34 (27) 73 (58) 19 (15) X2 ¼ 30.67, p 5 0.001* Doctors treating BM affliction 25 (28) 50 (56) 14 (16) 38 (36) 55 (52) 12 (12) 35 (28) 75 (59) 16 (13) X2 ¼ 2.81, p ¼ 0.59 Doc & RF treating BM affliction 26 (29) 43 (48) 20 (23) 28 (26) 64 (61) 13 (13) 27 (21) 77 (61) 22 (18) X2 ¼ 6.03, p ¼ 0.197 Belief in EE 56 (63) 30 (34) 3 (3) 49 (47) 53 (50) 3 (3) 36 (28) 84 (67) 6 (5) X2 ¼ 25.75, p 5 0.001* EE causing MHD 26 (29) 34 (38) 29 (33) 28 (26) 64 (61) 13 (13) 15 (12) 99 (78) 12 (10) X2 ¼ 41.25, p 5 0.001* RF treating EE affliction 54 (61) 18 (19) 17 (20) 40 (38) 55 (52) 10 (10) 31 (24) 73 (58) 22 (18) X2 ¼ 38.74, p 5 0.001* Doctors treating EE affliction 30 (34) 43 (48) 16 (18) 34 (32) 60 (57) 11 (11) 40 (32) 69 (55) 17 (13) X2 ¼ 2.78, p ¼ 0.595 Doc & RF treating EE affliction 28 (32) 36 (40) 25 (28) 25 (24) 65 (62) 15 (14) 29 (23) 76 (60) 21 (17) X2 ¼ 12.04, p ¼ 0.01*
Notes: *Significant at 0.05. LR ¼ Likelihood ratio; RF ¼ religious figures; MHD ¼ mental health difficulties; BM ¼ black magic; EE ¼ evil eye. 7 8 M.S.I. Mullick et al.
Table 4. Multinomial logistic regression analysis.
Belief systems* Predictor variables B OR (95% CI) Sig.
Belief in Jinn possession Female gender 0.61 1.8 (1, 3.1) 0.023** Lower education 0.96 2.6 (1.4, 4.9) 0.003** Jinn causing MHD Female gender 0.4 1.5 (0.9, 2.5) 0.115 Lower education 1.1 3.2 (1.7, 6.2) 50.001** RF treating Jinn affliction Female gender 0.11 1.1 (0.6, 1.8) 0.661 Lower education 1.36 3.9 (1.9, 7.6) 50.001** BM causing MHD Female gender 0.14 1.1 (0.6, 1.9) 0.593 Lower education 1.48 4.3 (2.2, 8.5) 50.001** RF treating BM affliction Female gender 0.24 1.2 (0.7, 2.1) 0.359 Lower education 1.59 4.9 (2.5, 9.5) 50.001** Belief in EE Female gender 0.67 1.9 (1.2, 3.2) 0.007** Lower education 1.27 3.5 (1.9, 6.6) 50.001** EE causing MHD Female gender -0.1 0.9 (0.4, 1.6) 0.731 Lower education 1.62 5 (2.3, 10.9) 50.001** RF treating EE affliction Female gender 0.57 1.7 (1, 3) 0.033** Lower education 1.78 5.9 (2.9, 11.9) 50.001**
Notes: *The reference category is: No. **Significant at 0.05. RF ¼ religious figures; MHD ¼ mental health difficulties; BM ¼ black magic; EE ¼ evil eye.
in Jinn possession, or to believe that Jinn, black magic, or evil eye could cause mental health problems. It also appeared that those with lower educational attainment had stronger beliefs in religious figures being suitable for treating the affliction. Multinomial logistic regression was conducted using gender and level of education as predictor variables and belief systems (entered individually) as outcome variables. For each outcome variable tested Goodness-of-fit test was used to assess whether the gender þ level of education model gave adequate predictions. Those models that outperformed the null model are summarised in Table 4. As can be seen, female gender predicted beliefs in Jinn possession and evil eye and
Downloaded by [Mohammad Mullick] at 10:23 27 August 2012 responses advocating religious figures as treating authority for mental health difficulties attributed to evil eye affliction. A low education predicted beliefs in Jinn possession and evil eye; beliefs that evil eye and black magic could cause mental health difficulties; and belief that religious figures are best placed at treating affliction by supranatural entities.
Discussion The majority of the present sample believed in the existence of Jinn, with a relatively smaller proportion believing in the existence of black magic and evil eye. This may be related to the fact that the Islamic literature (including) Qur’an put more emphasis on Jinn than the other two entities. For instance, Jinn is mentioned in 29 different sites in the Qur’an whereas, black magic and evil eye are mentioned only a few times. Furthermore, some scholars regard believing in the existence of Jinn as a part of the Islamic faith but opinions differ in relation to belief in black magic and evil eye. Mental Health, Religion & Culture 9
With regards to gender, females were more likely than males to believe in the existence of Jinn and evil eye, which supports earlier research (Khalifa et al., 2011). They were also more likely than males to cite religious figures as the treating authority for diseases attributed to affliction by black magic. However, these results are compounded by the fact that females had lower educational attainment in general. Gender disparity in regards to access to health care and education is not uncommon in South Asia (Fikree & Pasha, 2004). It may also be related to confounding factors – such as religiosity and history of mental health difficulties among participants – or to prestige bias which may occur if participants answer questions in the way they think the questioner wants them to answer rather than according to their true beliefs. Our findings showed that participants with a higher educational attainment were less likely than the other two groups (primary or below, or secondary education) to believe in jinn possession; to believe that Jinn, black magic, or evil eye could cause mental health problems; or to cite religious figures as the treating authority for diseases thought to be attributed by Jinn, black magic, or evil eye. This is not surprising as in Muslim countries; it is often the Imam who treats mental health problems. However, these people would not qualify for counselling certification due to a lack of formal counselling qualifications (Haque, 2004). Our findings may indicate that those with higher education attainment are more attuned to accepting medical explanations for diseases, or that they are more likely to be able to delineate religion from science. The link between ‘‘modernity’’ and tradition is complex in Islam. Dein et al. (2008) examined the notion of Jinn and misfortune among Bangladeshis in east London, one of most deprived areas in the UK with high indices of social disadvantage, and reported that belief in Jinn was common place. And that most participants believed that fate was largely influenced by external factors that were outside their control of which Jinn was cited as an example. Dein et al. (2008) argued that education does not necessarily transform beliefs about illness causation of and healing in a globalised world. Wider economic, social and cultural factors have a highly significant impact on these beliefs. To our knowledge, this study is the first that explored beliefs about Jinn, black magic and Evil eye in Bangladesh. However, the study has a number of limitations. First, the sample size was relatively small. Second, the study was conducted in a single centre in Dhaka which means that the sample may not be representative of Muslim beliefs as a whole. Therefore, the results cannot be generalised to all Muslims in Bangladesh. Third,
Downloaded by [Mohammad Mullick] at 10:23 27 August 2012 the use of an invalidated questionnaire is a major limitation of this study. However, it must be noted that validating this type of questionnaires is difficult as prestige bias may occur if participants answer questions in the way they think the questioner wants them to answer rather than according to their true beliefs. Fourth, while translation had the advantage of allowing non English Speaking participants to participate in the study, back translation would have been preferable. Finally, lack of information about history of mental health difficulties among participants can be seen as a limitation as history of such difficulties mental health difficulties may have influenced beliefs about supernatural entities.
Conclusions Our results deserve attention from practitioners in the field of mental health care. Practitioners need to be mindful that beliefs about Jinn, black magic and evil eye are not uncommon among Muslim. Also that appeal to supranatural explanations is not 10 M.S.I. Mullick et al.
uncommon at times of distress in general. It seems sensible therefore for practitioners to allow patients to express their views about illness causation without condemning these beliefs, although the underlying psychiatric disorders should be treated using conventional medical methods. Furthermore, practitioners need to be prepared to seek the help of religious leaders if necessary or requested. Religious figures may help shed more light on the religious aspects of a patient’s presentation. Although knowledge and respect of the Muslim religion is important, a health professional of the same religion may cause the patient to feel that details of their condition may be disseminated amongst their community (Cinnirella & Loewenthal, 1999). Muslims who seek mental health care prefer counsellors with an understanding of Islam (Weatherhead & Daiches, 2010; or their culture race [Kelly, 1996]) and treated with a combined care package consisting of Qur’anic health and Western medicine (Abu-Ras & Abu-Bader, 2008; Kelly, 1996), however they may instead prefer using private prayer rather than an Imam (Weatherhead & Daiches, 2010). Although religious leaders are often the first-line mental health care providers to Muslims (Osman, Milstein, & Marzuk, 2005) they are not trained to be a referral agent into conventional medicine, which often leaves the patient receiving inadequate psychiatric assessments or treatments (Budman, Lipson, & Meleis, 1992). Liaison between the Muslim communities and mental health services should be therefore encouraged. Further research is needed to confirm the prevalence of the beliefs in Bangladesh and examine the relationship between patients’ explanatory models of illness causation, and outcome from health services. Furthermore, the issues which arise out of conventional mental health services working collaboratively with religious figures deserve further attention, in particular in relation to identifying potential pitfalls and models of good practice.
Acknowledgements We thank all participants for their help and cooperation.
References
Abdel-Khalek, A.M. (2007). Religiosity, happiness, health, and psychopathology in a probability sample of Muslim adolescents. Mental Health, Religion & Culture, 10, 571–583. Downloaded by [Mohammad Mullick] at 10:23 27 August 2012 Abdel-Khalek, A.M. (2008). Religiosity, health and well-being among Kuwaiti personnel. Psychological Reports, 102(1), 181–184. Abu-Ras, W. (2003). Barriers to services for Arab immigrant battered women in a Detroit suburb. Journal of Social Work Research and Evaluation, 4(1), 49–66. Abu-Ras, W. (2007). Cultural beliefs and service utilization by battered Arab immigrant women. Violence Against Women, 13(10), 1002–1028. Abu-Ras, W., & Abu-Bader, S.H. (2008). The impact of the September 11, 2001, attacks on the well- being of Arab Americans in New York City. Journal of Muslim Mental Health, 3, 217–239. Al-Ashqar, U.S. (2003). The world of the Jinn & devils in the light of the Qur’an and Sunnah, Islamic Creed Series, Volume 3. Columbia, NC: International Islamic Publishing House. Al-Krenawi, A., & Graham, J.R. (1999). Social work and Koranic mental health healers. International Social Work, 42(1), 53–65. Aloud, N. (2004). Factors affecting attitudes toward seeking and using normal mental health and psychological services among Arab-Muslims population (Doctoral dissertation, Ohio State University, USA). Retrieved from http://etd.ohiolink.edu/send-pdf.cgi?osu1078935499. Mental Health, Religion & Culture 11
Asiatic Society of Bangladesh. (2000). Banglapedia: National Encyclopaedia of Bangladesh. Retrieved September 14, 2010 from, http://www.banglapedia.org/httpdocs/HT/B_0141.HTM. Bangladesh Bureau of Statistics. (2004). National Accounts Statistics (Provisional Estimates of GDP, 2003-04 and Final Estimates of GDP, 3002-03). Dhaka: Bangladesh Bureau of Statistics. Bangladesh Bureau of Statistics. (2009). Statistical yearbook of Bangladesh. Dhaka: Bangladesh Bureau of Statistics. Bayer, R.S., & Shunaigat, M. (2002). Socio-demographic and clinical characteristics of possessive disorder in Jordan. Neuroscience, 7(1), 46–49. Budman, C.L., Lipson, J.G., & Meleis, A.I. (1992). The cultural consultant in mental health care: The case of an Arab adolescent. American Journal of Orthopsychiatry, 62(3), 359–370. Cinnirella, M., & Loewenthal, K.M. (1999). Religious and ethnic group influences on beliefs about mental illness: A qualitative interview study. British Journal of Medical Psychology, 72(4), 505–524. Cochrane, R. (1983). The social creation of mental illness. London: Longma. Dein, S. (1997). ABC of mental health: Mental health in a multiethnic society. British Medical Journal, 315, 473–476. Dein, S., Alexander, M., & Napier, A.D. (2008). Jinn, psychiatry and contested notions of misfortune among East London Bangladeshis. Transcultural Psychiatry, 35(1), 31–55. El-Islam, M.F. (1995). Cultural aspects of illness behaviour. The Arab Journal of Psychiatry, 6, 13–18. Fikree, F.F., & Pasha, O. (2004). The role of gender in health disparity: The South Asian context. British Medical Journal, 328, 823–826. Haque, A. (2004). Religion and mental health: The case of American Muslims. Journal of Religion and Health, 43(1), 45–58. Kakar, D.N. (1988). Primary health care and traditional medicine practitioners. New Delhi: Sterling. Khalifa, N., & Hardie, T. (2005). Possession and Jinn. Journal of Royal Society of Medicine, 98, 351–353. Khalifa, N., Hardie, T., Latif, S., Jamil, I., & Walker, D.M. (2011). Beliefs about Jinn, Black Magic and Evil Eye among Muslims: Age, gender and first language influences. International Journal of Culture and Mental Health, 4(1), 68–77. Kelly, E.W.J. (1996). Muslims in the United States: An exploratory study of universal and mental health questions. Counseling & Values, 40, 206–219. Littlewood, R. (2004). Possession states. Psychiatry, 3, 8–10. Olusesi, O.A. (2008). The relationship between causal beliefs about mental illness and marital instability, and help seeking preferences of Nigerian immigrants (Doctoral dissertation, New York University School of Social Work, USA). Osman, M.A., Milstein, G., & Marzuk, P.M. (2005). The Imam’s role in meeting the counselling needs of Muslim communities in the United States. Psychiatric Services, 56(2), 202–205. Downloaded by [Mohammad Mullick] at 10:23 27 August 2012 Weatherhead, S., & Daiches, A. (2010). Muslim views on mental health and psychotherapy. Psychology and Psychotherapy: Theory, Research and Practice, 83, 75–89.